Therapy over the phone as effective as face-to-face

A new study reveals that cognitive therapy over the phone is just as effective as meeting face-to-face. The research was published today, 28 September, in the journal PLoS ONE.

Researchers at the University of Cambridge together with the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care (NIHR CLAHRC) and NHS Midlands & East also found that providing talking therapy over the phone increases access to psychological therapies for people with common mental disorders and potentially saves the NHS money.

For the study, data from 39,000 patients in seven established Improving Access to Psychological Therapies (IAPT) services (an initiative which aims to expand the availability of psychological therapies) in the East of England were used to compare Cognitive Behavioural Therapy (CBT) delivered face-to-face versus over the phone. For all but an infrequent, identifiable clinical group with more severe illness, therapy over the phone was as effective as face to face, and the cost per session was 36.2% lower.

Patients may be unable to access health services due to transport problems, work commitments and physical disability, among many reasons. So increasing availability of talking therapies over the phone will make mental health services more accessible to patients.

On the back of the study results, NHS Midlands & East has instigated a regional training programme to standardise service delivery and ensure therapists are competent at phone contacts. The training programme has recently been extended into a partnership with a third party organisation.

Professor Peter Jones, Principal Investigator of the study from the University of Cambridge, said: "Providing therapy over the phone will not only help individuals gain much-needed access to mental health treatment, it will provide a more cost effective way of providing these services at a time when everyone is concerned about cutting costs."

Mental health illnesses affect one in four adults in Britain every year. Additionally, the NHS spends more on mental health than it does on cancer, heart disease, stroke and asthma put together (a total of £9.95 billion in 2010-2011), with general practitioners spending more than a third of their time on mental health issues.

About IAPT:

The IAPT programme arose from a national desire to improve access to talking therapies for common mental health problems. It targets mild to moderate depression and anxiety which are the commonest mental health problems seen in general practice, causing an enormous health burden at the population level. People with common mental health problems have been subject to a long and uncertain wait for treatment via the NHS and so the introduction of IAPT services takes a significant step towards widening access to mental health services.

Professor Jones added: "The beauty of the IAPT programme is that it places the patient at the centre of their care and enables research to be used as a tool to support this."

In the IAPT programme, patients complete a number of disorder-specific questionnaires at every contact with the therapist, which provide accurate information that is used to their individual treatment and a platform of routine outcomes data to inform service improvements.

Throughout the implementation of IAPT in this region, the CLAHRC (a collaboration between the University of Cambridge and the Cambridgeshire and Peterborough NHS Foundation Trust) and NHS Midlands & East have worked in close partnership to ensure the programme meets local population need and improves patient care by effectively translating research into practice. Monthly meetings between researchers, commissioners, managers and clinicians meant that all relevant groups were involved in defining the research questions and interpreting the data, enabling them to share best practice and "pull through" the findings into service provision. Moreover, the work of the CLAHRC has shown the power of sharing routine health data by enabling the outcome data to be looked at in a meaningful way to provide feedback to local services on how they can see patients more effectively and achieve better value for money.

1. The paper 'Comparative Effectiveness of Cognitive Therapies Delivered Face-To-Face or Over the Telephone: An Observational Study Using Propensity Methods' is scheduled for publication by PLoS ONE on 28 September 2012.

2. NIHR CLAHRC-CP http://www.clahrc-cp.nihr.ac.uk/ This is a new approach to applied health research whereby researchers and those in the NHS and social care who will consume the new knowledge produced work closely throughout the process. They jointly define the questions to be answered so that these fit the questions relevant to the NHS; regular discussions during the research process ensure the work stays on track and that the relevant managers, commissioners and services are ready to "pull-through" the research once the results are clear. This process of co-production aims to close the translational gap between research and clinical practice - the Type 2 gap as defined by the Cooksey Report (http://www.hm-treasury.gov.uk/d/pbr06_cooksey_final_report_636.pdf).

3. Improving access to psychological therapies (IAPT; http://www.iapt.nhs.uk/) is a massive expansion in the availability of psychological therapies through self-referral, primary care and other routes. IAPT uses evidence-based therapies, largely cognitive behavioural therapy (CBT). It was originally aimed at the common mental disorders of depression and anxiety, but is being expanded to encompass the psychological needs of people with long-term physical conditions, and is being orientated to include children and young people.

4. NHS Midlands & East https://www.eoe.nhs.uk/home.php and CLAHRC-CP worked in partnership with Relate to develop a bespoke Telephone Intervention Skills Training course which has been specifically designed around the key skills identified by experienced Talking Therapists as paramount to the safe and effective delivery of psychological therapies to members of the public over the telephone. The course has been specifically designed for therapists who have patients who are housebound; agoraphobic; have childcare or transport difficulties; living long distances from clinical premises; working away from home - even abroad; on shifts; "too busy"; nervous of committing themselves or even unable to attend appointments due to weather conditions. The course broadens the therapist's skill set, provides a greater variety of service options, and enables a greater throughput of patients and counts towards practitioner CPD hours. This acclaimed course enables therapists to work from home; work when there isn't a room free; work at hours to suit themselves and the patients; and keep the continuity of psychological therapy going. The training programme has been successfully delivered to over 150 members of staff in the East of England (including Psychological Wellbeing Practitioners, High Intensity Therapists, Counsellors, Service Managers and partnership colleagues) with huge success and has attracted extremely positive feedback on the appropriateness of its content, application to practice and overall standard of training delivery.

5. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

6. NHS Midlands and East is made up of the strategic health authorities of NHS East Midlands, NHS East of England and NHS West Midlands.
The role of NHS Midlands and East is to ensure that local health systems operate effectively and efficiently and that national standards and priorities are met in order to continually improve services for patients.

The organisation works in partnership with local NHS trusts and other partners. NHS Midlands and East is ultimately accountable to the Secretary of State for Health.

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